On
March 17, 1996, the New York City Fire Department became not only
the primary provider of pre-hospital emergency care in the five
boroughs, but the largest fire department-based EMS in the country.
Many of the improvements in pre-hospital medical care that have
been implemented since then have been a direct result of this merger.
These advances have impacted the EMS Bureau as well as the Fire
Department.

Implementation of the CFR-D program has helped create a true, three-tiered
emergency medical system in New York City. Certified First Responder
Defibrillator (CFR-D) is the first and basic level of training,
followed by Basic Life Support and then Advanced Life Support.

Studies by the American Heart Association have shown a dramatic
increase in the survival rates for out-of-hospital cardiac arrest
victims who have quick and efficient CPR and defibrillation, followed
by rapid access to the 911 system. The merger of FDNY and the NYC
EMS has made this tiered response more seamless and effective, generating
a downward trend in response times and saving the lives of countless
New Yorkers every year.

These trends of lower response times and increased survival were
not always the case.

In the early years (1870) of "pre-hospital" emergency
care in New York City, ambulances were dispatched via telegraph
from Bellevue Hospital's Centre Street branch. Ambulances were staffed
with a highly trained medical doctor or surgeon from the hospital.
In the first year alone, they responded to more than 1800 calls
for help throughout the city.

However, as the call volume increased, if a doctor was not available
to respond to a call, the hospital would place other personnel (such
as an orderly or -in a rare instance- a janitor or a member of the
kitchen staff) on the ambulance. With little or no training, the
"ambulance driver" would respond to calls for help from
the sick or injured, frequently arriving at the scene hours later
without the proper equipment or training to treat the patient. Because
of this lack of training and technology, the majority of the more
seriously injured patients already had expired by the time the ambulance
reached them and almost surely by the time they reached the hospital.

As the population continued to grow throughout the 19th century
and into the industrial revolution of the early 20th century, the
needs for additional training and easier access to rapid pre-hospital
emergency medical care became apparent. Injuries caused by mechanical
devices or as a result of industrial accidents were becoming more
and more common.

From
1909 through 1929, ambulances in New York City operated under the
supervision of the Board of Ambulance Service, which was presided
over by the Police Commissioner. During this period, the medical
community was beginning to realize the benefits of good pre-hospital
medical care and rapid transport. By this time, 45 hospital-based
ambulances12 municipal and 33 voluntary-responded to almost
343,000 emergency calls annually.

Ambulance crews were comprised of motor vehicle operators (ambulance
drivers) and patient care personnel with varying levels of training,
ranging from hospital-ward orderlies to physicians and "ambulance
surgeons." Ambulance personnel worked at their regular duties
in the hospital and were "called out" when a request for
an ambulance was received. This often resulted in extended response
times and, occasionally, poor medical care, too. Each hospital interpreted
administrative procedures and practices concerning ambulance services
and operations according to its own set of rules, which almost always
resulted in a significant variation of service provided.

Pre-hospital care generally was limited to a "scoop and run"
operation. Additionally, ambulances transported patients back to
the hospitals in which they were based, regardless of whether another
hospital was closer or better equipped to handle that specific patients
medical condition. This often left whole areas of the city without
ambulance coverage. Furthermore, the Police Department had no real
jurisdiction over the ambulances; they were powerless to prevent
hospital administrators from assigning all of their ambulances to
transfers and holding none available for emergencies.

By the late 1960s, with the annual total of emergency runs nearing
400,000, the Department of Hospitals Commissioner centralized all
of the city municipal ambulances under the control and direction
of the Ambulance and Transportation Division of the Department of
Hospitals. For the first time in nearly 100 years, it became possible
to establish uniformity in the city ambulance service, allowing
for a more structured approach to pre-hospital care.